Chest pain. CHEST PAIN OVERVIEWIt is hard to know what to do when you feel pain or discomfort in the chest. Is it a heart attack or another, less serious problem Because chest pain can be a sign of a heart attack, if the pain is due to heart disease, it is important to seek help and get treatment as quickly as possible. The important causes, typical signs and symptoms, diagnostic tests, and initial treatment of chest pain will be reviewed here. CHEST PAIN CAUSESChest pain generally originates from one of the organs in the chest heart, lung, or esophagus or from the components of the chest wall skin, muscle, or bone. Occasionally, organs close to the chest, such as the gall bladder or stomach, may cause chest pain. Pain in the chest may also be the result of neck pain that is referred to the chest, called referred pain. A Full Fledged NextGen Xbox May Happen, Says Microsofts Albert Penello Rocksteady Studios Superman Game Reveal Coming Next Week Rumor. 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Angina  All organs and tissues in the body require oxygen and nutrients carried in the blood. The heart pumps oxygen and nutrient rich blood through a huge network of arteries throughout the body, which includes vessels that supply blood to the heart muscle. These vessels, called coronary arteries, lie on the surface of the heart and branch into smaller vessels located within the muscle figure 1. In people with coronary heart disease CHD, the coronary arteries become clogged with fatty deposits figure 2. The deposits, called plaques, cause the coronary arteries to narrow and may prevent a normal amount of oxygen rich blood from reaching the heart muscle. This is called cardiac ischemia. Angina is the term for chest pain caused by ischemia. Angina is particularly common during physical activity, when the heart rate and pressure are increased due to the hearts demand for more oxygen. Angina develops if the demand for oxygen exceeds the amount of oxygen delivered to the heart muscle by the coronary arteries. Heart attack  A heart attack, or myocardial infarction MI, occurs when the surface covering of a fatty plaque ruptures. Gregg Braden Torrent Pdf. A blood clot thrombus can form on the plaque, which can partially or completely block the artery. This blockage slows or blocks blood flow to the area of heart muscle fed by that artery. If this continues for more than 1. During a heart attack, the patient may feel a discomfort that is similar to an episode of ischemia angina, although more prolonged and intense. Describing chest pain  Chest pain caused by angina or a heart attack may be similar to or different from chest pain caused by other conditions. Depending upon the cause, chest pain can have varying qualities sharp, dull, burning, can be located in one or several areas middle of the chest, upper or left chest, back, arms, jaw, neck, or the entire chest area, pain may worsen with activity and improve with rest, and there may be other associated symptoms sweating, nausea, rapid heart rate, shortness of breath. Quality of the pain Patients with ischemia of the heart are likely to report chest discomfort rather than pain. A person may describe their pain as squeezing, tightness, pressure, constriction, strangling, burning, heart burn, fullness in the chest, band like sensation, knot in the center of the chest, ache, heavy weight on chest like an elephant sitting on the chest, or like a bra that is too tight. In some cases, the discomfort cannot be described, but the patient may describe the pain by placing a fist in the center of the chest, known as the Levine sign. People with pain that is not due to ischemia often describe their pain as sharp or stabbing. Location of the pain Ischemic chest pain is usually not felt in any specific spot, but rather throughout the chest. The patient may actually have difficulty describing the exact location of the pain. Cardiac pain often involves the center of the chest or upper abdomen. If the pain is felt only on the right or left side, and not in the center of the chest, it is less likely to be cardiac ischemia. If the patient is able to point with a finger to one area of pain, it is unlikely to be caused by cardiac ischemia. Radiation of pain The chest pain of cardiac ischemia often spreads to other areas of the upper body. This may include the neck, throat, lower jaw, teeth feeling like a toothache, or the shoulders and arms. Sometimes, pain is felt in the wrists, fingers, or back between the shoulder blades. Timing of the pain Ischemic pain tends to come on gradually and get worse over time it generally lasts from two to five minutes after resting if it is related to exertion. In contrast, noncardiac pain can begin suddenly and feel worst in the beginning. It is often unrelated to exertion. Noncardiac pain may last only a few seconds or may persist for hours. Pain may improve with nitroglycerin or may persist and be severe. Pain that has been unchanged in severity and constant over days or weeks is not likely to be angina or a heart attack. Things that make the pain better or worse The patient will be questioned carefully about things that make the pain better or worse. For example, if the pain begins during an activity that increases physical exertion, such as walking up stairs, sexual intercourse, or raking leaves, and the pain is relieved within minutes of resting, it could be angina. The reason for this is that exercise increases the hearts need for oxygen rich blood, and the need decreases as the person rests. Other things that can increase oxygen demand in the heart include emotional stress, exposure to cold, and physical effort shortly after a meal. If the pain is relieved with nitroglycerin, a medicine used to treat angina, it suggests but does not prove that ischemia is the cause. Other conditions, especially muscular spasms or esophageal spasm, may also improve with nitroglycerin. If eating a meal or taking antacids always relieves the pain, it could be caused by a problem with the esophagus or stomach. Finally, the pain of ischemia is not usually affected by taking a deep breath or by pressing on the area of discomfort. Asme B 30.9 more. Ischemic pain tends to be the same regardless of body position, although some patients with ischemia feel relief when sitting up, especially if they lean forward. Associated symptoms Patients having severe angina or a heart attack may have other symptoms in addition to or even instead of discomfort in the chest. These can include Shortness of breathNausea, vomiting, or belchingSweatingCold, clammy skinIrregular or rapid heart ratePalpitationsFatigueDizzinessFaintingIndigestionVague abdominal discomfortTingling sensation in either arm more often the left or shoulder. Cardiac risk factors  The likelihood that a particular person is having ischemia is based upon their symptoms, physical examination, as well as the persons underlying risk of coronary disease. For example, an elderly person with multiple risk factors, including a prior MI, peripheral vascular disease claudication, stroke, heavy smoking, high blood pressure, diabetes, high cholesterol, and a family history of heart disease would be treated as a person with a high risk of coronary disease despite having symptoms that are not typical for angina. On the other hand, if a person in a very low risk category reports chest pain, the remote possibility of coronary disease is not ignored, although other possible causes are also investigated.